Healthcare Provider Details

I. General information

NPI: 1285077271
Provider Name (Legal Business Name): YONAS W GEBREMARIAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 TABLE MESA DR
BOULDER CO
80305-5800
US

IV. Provider business mailing address

3600 TABLE MESA DR
BOULDER CO
80305-5800
US

V. Phone/Fax

Practice location:
  • Phone: 303-499-4244
  • Fax: 303-497-2204
Mailing address:
  • Phone: 303-499-4244
  • Fax: 303-497-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16726
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number16726
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16726
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: